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https://www.readbyqxmd.com/read/27923485/randomized-multicenter-trial-comparing-sternotomy-closure-with-rigid-plate-fixation-to-wire-cerclage
#1
Keith B Allen, Vinod H Thourani, Yoshifumi Naka, Kendra J Grubb, John Grehan, Nirav Patel, T Sloane Guy, Kevin Landolfo, Marc Gerdisch, Mark Bonnell, David J Cohen
OBJECTIVE: To evaluate sternal healing, complications, and costs after sternotomy closure with rigid plate fixation or wire cerclage. METHODS: This prospective, single-blinded, multicenter trial randomized 236 patients at 12 US centers at the time of sternal closure to either rigid plate fixation (n = 116) or wire cerclage (n = 120). The primary endpoint, sternal healing at 6 months, was evaluated by a core laboratory using computed tomography and a 6-point scale (greater scores represent greater healing)...
November 17, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27922523/a-simple-and-effective-technique-for-anatomical-approximation-of-the-upper-pericardium-using-hemostatic-clips
#2
Mubassher Husain, Metesh Nalin Acharya, Ian Cummings, Shahzad Gull Raja
Closure of the pericardium is important to protect bypass grafts, the great vessels, and the heart from injury due to sternal dehiscence. Furthermore, it is reported to reduce the formation of pericardial adhesions and thus facilitate entry into the chest at resternotomy. We here describe a simple, reproducible, and effective technique for tension-free approximation of the upper pericardium by applying small hemostatic clips to the preserved thymic fascia overlying the pericardium.
December 2, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27913736/additional-effects-of-topical-tranexamic-acid-in-on-pump-cardiac-surgery
#3
Noppon Taksaudom, Sophon Siwachat, Apichat Tantraworasin
OBJECTIVE: Postoperative bleeding after cardiac surgery is commonly associated with hyperfibrinolysis. This study was designed to evaluate the efficacy of topical tranexamic acid in addition to intravenous tranexamic acid in reducing bleeding in cardiac surgery cases. METHODS: From July 1, 2014 to September 30, 2015, 82 patients who underwent elective on-pump cardiac surgery were randomized into a tranexamic acid group and a placebo group. In the tranexamic acid group, 1 g of tranexamic acid dissolved in 100 mL of normal saline solution was poured into the pericardium during sternal closure; the placebo group had 100 mL of saline only...
December 2, 2016: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/27909272/-novel-sternum-closure-technique-using-ultra-high-molecular-weight-polyethylene-sutures
#4
Takashi Ando, Daichi Akiyama, Hiroshi Okada, Hiroshi Furukawa, Makoto Takeda
During cardiac surgery through midline sternotomy, sternum closure metal wires are usually used for. However, metal wires may damage the sternum and cause artifacts on X-ray. Therefore, we use a novel sternum closure technique in which metal wire is replaced by ultra-high molecular weight polyethylene(UHMWP) sutures. We have used this technique for 89 patients in 2014 and reviewed our experience. UHMWPs are often used for bone fracture cerclage, particularly in the vertebral body. UHMWPs may avoid sternal "cheese-cut" dehiscence...
December 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27853697/primary-closure-of-a-sternal-cleft-in-a-neonate
#5
Shaal Ramdial, Desigan Pillay, Anil Madaree
A three day old neonate was referred to our department with a problem of a sternal cleft. Sternal clefts are often associated with a myriad of other abnormalities ranging from mild to severe. We present our experience with such a problem, and review the current literature concerning it.
September 2016: World Journal of Plastic Surgery
https://www.readbyqxmd.com/read/27740952/rigid-sternal-fixation-versus-modified-wire-technique-for-poststernotomy-closures-a-retrospective-cost-analysis
#6
Jiwon Sarah Park, Jennifer H Kuo, J Nilas Young, Michael S Wong
BACKGROUND: Rigid sternal fixation (RSF) has been shown to reduce sternal wound complications in high-risk patients. However, the higher initial cost continues to deter its use. This study evaluates the cost of caring for high-risk sternotomy patients who underwent RSF compared with those who underwent sternal closure with a modified wire technique (MWT). METHODS: A retrospective single institution review of high-risk patients who underwent MWT (n = 45) and RSF (n = 30) for primary sternal closure from 2006 to 2009 was conducted...
October 6, 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/27720371/delayed-sternal-closure-in-infant-heart-surgery-the-importance-of-where-and-when-an-analysis-of-the-sts-congenital-heart-surgery-database
#7
Kristen Nelson-McMillan, Christoph P Hornik, Xia He, Luca A Vricella, Jeffrey P Jacobs, Kevin D Hill, Sara K Pasquali, Diane E Alejo, Duke E Cameron, Marshall L Jacobs
BACKGROUND: Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk. METHODS: Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality were included...
October 6, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27720369/extubation-failure-in-neonates-after-cardiac%C3%A2-surgery-prevalence-etiology-and%C3%A2-risk-factors
#8
Shinya Miura, Nao Hamamoto, Masaki Osaki, Satoshi Nakano, Chisato Miyakoshi
BACKGROUND: The purpose of this study was to explore the prevalence, etiology, and risk factors of extubation failure (EF) in post-cardiac surgery neonates. METHODS: Neonates (30 days old or younger) who underwent cardiac surgery and were admitted to the cardiac intensive care unit between September 2010 and February 2016 were included. The prevalence and etiology of EF, defined as reintubation within 48 hours, were reviewed. Demographic, operative, and perioperative data were retrospectively collected...
October 6, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27667103/-application-of-new-chest-holder-in-the-median-sternotomy-for-open-heart-surgery-in-adults
#9
C Y Xu, D G Feng, J X Wang, Z Y Cheng, F Wang, B Lin, Z L Xie, L N Suo, P Du
Objective: To explore the application of new chest holder in the median sternotomy for open heart surgery in adults. Methods: Two hundred adult patients in Henan Provincial People's Hospital from May 2013 to May 2015 were enrolled in the study and randomly divided into two groups. Experimental group included 100 cases who accepted the new type of chest holder in the open heart surgery. Control group were also composed of 100 cases whose sternums were fixed with the pure steel wire cerclage. Sternal closure time was recorded since the sternum closing...
September 13, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27666782/planned-versus-unplanned-reexplorations-for-bleeding-a-comparison-of-morbidity-and-mortality
#10
Todd C Crawford, J Trent Magruder, Joshua C Grimm, Christopher M Sciortino, Kaushik Mandal, Kenton J Zehr, Duke E Cameron, Glenn J Whitman, John V Conte
BACKGROUND: Mediastinal reexplorations for bleeding are associated with significant morbidity and mortality. This study hypothesized that bleeding patients who undergo delayed chest closure after an initial operation experience similar outcomes in comparison with patients who have initial chest closure and later require an unplanned reexploration. METHODS: This study included all patients in the Johns Hopkins University School of Medicine (Baltimore, MD) institutional Society of Thoracic Surgeons (STS) database who underwent cardiac surgical procedures or thoracic transplantation from 2011 to June 2014, had an intraoperative red blood cell transfusion requirement of 2 units or more, and required mediastinal reexploration for bleeding...
September 22, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27639711/wire-cerclage-can-restore-the-stability-of-the-thoracic-spine-after-median-sternotomy-an-in-vitro-study-with-entire-rib-cage-specimens
#11
Christian Liebsch, Nicolas Graf, Hans-Joachim Wilke
PURPOSE: The influence of the anterior rib cage on the stability of the human thoracic spine is not completely known. One of the most common surgical interventions on the anterior rib cage is the longitudinal median sternotomy and its fixation by wire cerclage. Therefore, the purpose of this in vitro study was to examine, if wire cerclage can restore the stability of the human thoracic spine after longitudinal median sternotomy. METHODS: Six fresh frozen human thoracic spine specimens (C7-L1, 56 years in average, range 50-65), including the intact rib cage without intercostal muscles, were tested in a spinal loading simulator and monitored with an optical motion tracking system...
September 17, 2016: European Spine Journal
https://www.readbyqxmd.com/read/27607752/efficacy-of-dialkylcarbamoylchloride-coated-dressing-in-management-of-colonized-or-infected-neonatal-and-pediatric-wounds
#12
Vita Boyar
BACKGROUND: Wound healing is a dynamic process that normally follows a predictable cascade of events. A common cause of delayed wound healing or wound dehiscence is increased colonization with microbes, often leading to infection. Infection may impede the healing process by inducing an undesirable inflammatory response. Systemic antibiotics and topical antiseptics are mainstays of treatment, but their adverse side effects and the potential for emergence of resistant microbial strains have led to a search for alternative approaches for control of bioburden...
September 2016: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/27592573/-safety-of-surgical-therapy-for-neonate-aortic-coarctation-combined-with-ventricular-septal-defect
#13
Peng Huang, Jinwen Luo, Jian Liu, Xiaohui Yang, Xiaoming Peng, Pingbo Liu
OBJECTIVE: To evaluate the safety of surgical repair for neonatal aortic coarctation combined with ventricular septal defect.
 METHODS: Twenty-three aortic coarctation neonates received surgical treatment and their clinical data between April, 2013 and May, 2015 were analyzed retrospectively. All patients underwent coarctation repair + ventricular septal defect repair and mild hyperthermia cardiopulmonary bypass under the condition of general anesthesia. All patients were subjected to delayed sternal closure...
July 2016: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
https://www.readbyqxmd.com/read/27568126/creation-and-global-deployment-of-a-mobile-application-based-cognitive-simulator-for-cardiac-surgical-procedures
#14
Zachary E Brewer, William David Ogden, James I Fann, Thomas A Burdon, Ahmad Y Sheikh
Several modern learning frameworks (eg, cognitive apprenticeship, anchored instruction, and situated cognition) posit the utility of nontraditional methods for effective experiential learning. Thus, development of novel educational tools emphasizing the cognitive framework of operative sequences may be of benefit to surgical trainees. We propose the development and global deployment of an effective, mobile cognitive cardiac surgical simulator. In methods, 16 preclinical medical students were assessed. Overall, 4 separate surgical modules (sternotomy, cannulation, decannulation, and sternal closure) were created utilizing the Touch Surgery (London, UK) platform...
2016: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27556153/active-clearance-of-chest-tubes-reduces-re-exploration-for-bleeding-after-ventricular-assist-device-implantation
#15
Simon Maltais, Mary E Davis, Nicholas A Haglund, Louis Perrault, Sudhir S Kushwaha, John M Stulak, Edward M Boyle
Chest tubes are utilized to evacuate shed blood after left ventricular assist device (LVAD) implantation, however, they can become clogged, leading to retained blood. We implemented a protocol for active tube clearance (ATC) of chest tubes to determine if this might reduce interventions for retained blood. A total of 252 patients underwent LVAD implantation. Seventy-seven patients had conventional chest tube drainage (group 1), whereas 175 patients had ATC (group 2). A univariate and multivariate analysis adjusting for the use of conventional sternotomy (CS) and minimally invasive left thoracotomy (MILT) was performed...
November 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27528381/successful-surgical-treatment-of-traumatic-sternal-fracture-with-extensive-mediastinal-abscess-and-concomitant-mitral-valve-endocarditis-a-case-report
#16
Hiroshi Munakata, Yu Murakami, Katsuhito Mabuni, Hiroyuki Tsuchiya, Moriaki Shinzato, Takehiro Umemura, Tadao Kugai
BACKGROUND: A traumatic sternal fracture with extensive mediastinal abscess and concomitant native valve endocarditis is an extremely rare but catastrophic situation. CASE PRESENTATION: For 2 weeks, the co-infected patient was treated with aggressive debridement for the mediastinitis, change of vacuum-assisted closure therapy dressings, vegetectomy and valve repair through lower partial sternotomy, and delayed primary wound closure. CONCLUSIONS: To the best of our knowledge, this successful staged strategy has not been previously reported...
August 15, 2016: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/27487968/the-simultaneous-use-of-breast-reduction-and-internal-mammary-artery-perforator-flap-in-sternal-wound-reconstruction
#17
Kashyap Komarraju Tadisina, Richard L Drake, James E Zins, Raffi Gurunluoglu
Internal mammary artery perforator (IMAP)-based fasciocutaneous flaps have recently gained popularity in sternal wound reconstruction due to their decreased donor site morbidity. However, patients with significant macromastia or who are obese present a challenge when using these flaps due to their anatomy and associated comorbid conditions. Despite the prevalence of this population, there is a relative paucity of data on the use of local fasciocutaneous flaps and techniques to close sternotomy wounds in the obese population with hypertrophic or ptotic breasts...
August 2, 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/27484000/the-mid-term-outcome-of-primary-open-valvotomy-for-critical-aortic-stenosis-in-early-infancy-a-retrospective-single-center-study-over-18%C3%A2-years
#18
Claire Galoin-Bertail, André Capderou, Emre Belli, Lucile Houyel
BACKGROUND: The objective of this study was to examine early and long-term results of surgical aortic valvotomy in neonates and infants aged less than four months and to identify predictors of outcome. METHODS: Between August 1994 and April 2012, 83 consecutive patients younger than 4 months of age underwent open heart valvotomy for critical aortic stenosis in our institution. Median age was 17 days (range 0-111 days). We examined clinical records to establish determinants of outcome and illustrate long-term results...
2016: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/27475733/an-adjusted-calculation-model-of-reduced-heparin-doses-in-cardiopulmonary-bypass-surgery-in-a-chinese-population
#19
Yufeng Zhang, Kai Liu, Wei Li, Qian Xue, Jiang Hong, Jibin Xu, Lihui Wu, Guangyu Ji, Jihong Sheng, Zhinong Wang
OBJECTIVE: To investigate the safety and efficacy of an adjusted regimen of heparin infusion in cardiopulmonary bypass (CPB) surgery in a Chinese population. DESIGN: Prospective, single-center, observational study. SETTING: University teaching hospital. PARTICIPANTS: Patients having cardiac surgery with CPB were selected for this study using the following criteria: 18 to 75 years of age, undergoing first-time cardiac surgery with conventional median sternotomy, aortic clamping time between 40 and 120 minutes, and preoperative routine blood tests showing normal liver, renal, and coagulation functions...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27465093/surgical-treatment-of-mediastinitis-with-omentoplasty-in-ventricular-assist-device-patients-report-of-referral-center-experience
#20
Marina Pieri, Marcus Müller, Anna Mara Scandroglio, Panagiotis Pergantis, Alexandra Kretzschmar, Friedrich Kaufmann, Volkmar Falk, Thomas Krabatsch, Georg Arlt, Marian Kukucka, Evgenij Potapov
Mediastinitis is more frequent in patients with implantable ventricular assist devices (VAD) than in other cardiac surgery patients and carries significant mortality. We report our experience with a stepwise approach including aggressive debridement, jet lavage, vacuum assisted closure (VAC) dressing and finally coverage with well-vascularized and immune active omental flaps in VAD patients with infective mediastinitis.We retrospectively collected and analyzed data of patients with continuous flow VAD who underwent plasty with the omental flap due to mediastinitis at Deutsches Herzzentrum Berlin beween 1 January 2008 and 30 October 2015 ...
July 26, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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